Use of dexmedetomidine for the treatment of alcohol withdrawal syndrome in critically ill patients: a retrospective case series
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Alcohol withdrawal syndrome (AWS) continues to be a challenge to manage in the ICU setting, and the ideal pharmacological treatment continues to evolve. Dexmedetomidine is a newer agent approved for short-term sedation in the ICU, but its use in the treatment of AWS has been limited. We report a retrospective case series of ten patients who were identified as receiving dexmedetomidine for AWS as designated by electronic pharmacy records. All subjects were male, with a mean age of 53.6 years, and a mean ICU length of stay of 9.3 days. They were all diagnosed with AWS by DSM-IV criteria. All the study patients received dexmedetomidine during their hospital course as a treatment for AWS. Studied variables included demographic data, dose and duration of dexmedetomidine, other pharmaceutical agents, and hemodynamics. Dexmedetomidine was safe to use in all patients, although mechanical ventilation was still required in three patients. With dexmedetomidine, the autonomic hyperactivity was blunted, with a mean 12.8 % reduction in rate pressure product observed. Consideration should be given to the combined use of dexmedetomidine with benzodiazepines in the treatment of AWS.
- Kaim SC, Klett CJ, Rothfeld B. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry. 1969;125:1640–6.
- Sarff M, Gold J. Alcohol withdrawal syndromes in the intensive care unit. Crit Care Med. 2010;38(suppl):S494–S501.
- Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med. 2003;348:1786–95. CrossRef
- Cushman P Jr. Clonidine and alcohol withdrawal. Adv Alcohol Subst Abuse. 1987;7:17–28.
- Kamibayashi T, Maze M. Clinical uses of α2-adrenergic agonists. Anesthesiology. 2000;93:1345–9. CrossRef
- Gerlach AT, Dasta JF. Dexmedetomidine: an updated review. Ann Pharmacother. 2007;41:245–52. CrossRef
- Abramov D, Nogid B, Nogid A. The role of dexmedetomidine (Precedex) in the sedation of critically ill patients. P&T. 2005;30:158–61.
- Lakhlani PP, MacMillan LB, Guo TZ, McCool BA, Lovinger DM, Maze M, Limbird LE. Substitution of a mutant a2A-adrenergic receptor via ‘hit and run’ gene targeting reveals the role of this subtype in sedative, analgesic, and anesthetic-sparing responses in vivo. Proc Natl Acad Sci USA. 1997;94:9950–5. CrossRef
- Dexemetomidine (package insert). Lake Forest: Hospira, Inc.; 2008.
- Reiter PD, Pietras M, Dobyns EL. Prolonged dexmedetomidine infusions in critically ill infants and children. Indian Pediatr. 2009;46:767–73.
- Riihioja P, Jaatinen P, Oksanen H, Haapalinna A, Heinonen E, Hervonen A. Dexmedetomidine, diazepam, and propanolol in the treatment of ethanol withdrawal symptoms in the rat. Alcohol Clin Exp Res. 1997;21:804–8. CrossRef
- Riihioja P, Jaatinen P, Haapalinna A, Kiianmaa K, Hervonen A. Effects of dexmedetomidine on rat locus coeruleus and ethanol withdrawal symptoms during intermittent ethanol exposure. Alcohol Clin Exp Res. 1999;23:432–8. CrossRef
- Le AD, Harding S, Juzytsch W, Funk D, Shaham Y. Role of alpha-2 adrenoreceptors in stress-induced reinstatement of alcohol seeking and alcohol self-administration in rats. Psychopharmacology. 2005;179:366–73. CrossRef
- Darrouj J, Puri N, Prince E, Lomonaco A, Spevetz A, Gerber DR. Dexmedetomidine infusion as adjunctive therapy to benzodiazepines for acute alcohol withdrawal. Ann Pharmacother. 2008;42:1703–5. CrossRef
- Maccioli GA. Dexmedetomidine to facilitate drug withdrawal. Anesthesiology. 2003;98:575–7. CrossRef
- Rovasalo A, Tohmo H, Aantaa R, Kettunen E, Palojoki R. Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report. Gen Hosp Psychiatry. 2006;28:362–3. CrossRef
- Baddigam K, Russo P, Russo J, Tobias J. Dexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients. J Intensive Care Med. 2005;20:118–23. CrossRef
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edn., text revision. Washington, DC: American Psychiatric Association; 2000. p. 216.
- Jones R, Knight PR, Hill AB. Rate pressure product. Anaesthesia. 1980;35:1010–1. CrossRef
- Williams D, McBride AJ. The drug treatment of alcohol withdrawal symptoms: a systematic review. Alcohol Alcohol. 1998;33:103–15.
- Use of dexmedetomidine for the treatment of alcohol withdrawal syndrome in critically ill patients: a retrospective case series
Journal of Anesthesia
Volume 26, Issue 4 , pp 601-605
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Alcohol withdrawal syndrome
- Pharmacological therapy
- Critical care
- Industry Sectors
- Author Affiliations
- 1. Division of Trauma and Critical Care, Department of Surgery, Winthrop University Hospital, 259 First Street, Mineola, NY, 11501, USA
- 2. Neurosciences Special Care Unit, Department of Neurosciences, Winthrop University Hospital, 259 First Street, Mineola, NY, 11501, USA